A variety of medical payment systems have heretofore been proposed illustrative of which are those disclosed in U.S. Pat. No. 4,491,725 granted to Lawrence E. Pritchard on Jan. 1, 1985 and in U.S. Pat. No. 4,858,121 which was granted to William B. Barber et al. on Aug. 15, 1989.
According to the proposals of the prior art, systems have been proposed which include one or more magnetic and manual entry data entry terminals at the health care provider facilities, various verification and authentication routines, data storage which includes lists of insurance companies or other payers together with lists of medical procedures for which such payers are obligated to make payments, schedules of permissible fees for such procedures and selected data related specifically to each covered patient.
Other proposals of the prior art have included examination of participants to determine their physical condition, identification of existing physical profiles and encouragement of changes in life styles, where indicated, to enhance the physical condition of the participant and to lessen the likelihood of the development of disease.
However, such systems have not heretofore featured the total health care function, for they have not integrated important elements of total health care such as comprehensive preventive health measures, the review of the necessity for implementing selected procedures including changes in life styles, the obtaining of second opinions, (i.e., utilization review/case management) and other functions contemplated by total health management such as ancillary services. Neither have they included integration of the active participation by a patient's employer or inclusion of a patients' own available cash balances. Accordingly, since these missing functions are important ingredients to extend proposals of the prior art to fully comprehensive medical care, there has continued to be a need for a system which provides full integration of each of the aforementioned activities.